摘要
目的 研究甘油三酯(TG)/高密度脂蛋白胆固醇(HDL-C)结合C反应蛋白(CRP)/白蛋白(Alb)预测腹膜透析患者死亡风险的价值.方法 回顾性分析2017年1月—2022年12月景德镇市第二人民医院和景德镇市第三人民医院收治的197接受腹膜透析的慢性肾功能不全患者的临床资料,统计腹膜透析患者死亡情况,根据腹膜透析患者是否死亡分为死亡组与存活组.比较两组临床资料,采用多因素逐步Cox回归模型分析腹膜透析患者死亡的危险因素,绘制受试者工作特征(ROC)曲线,评估TG/HDL-C、CRP/Alb及两者联合对腹膜透析患者死亡的预测价值.结果 197例腹膜透析患者死亡46例,病死率为23.35％.死亡组年龄、冠心病占比、糖尿病占比、高血压占比、使用他汀类药物占比、血小板计数、白细胞计数、中性粒细胞计数、中性粒细胞计数与淋巴细胞计数比值(NLR)、TG/HDL-C、CRP/Alb均高于存活组(P＜0.05),死亡组淋巴细胞计数、总胆红素均低于存活组(P＜0.05).多因素逐步 Cox 回归分析结果显示:高龄[OR=3.080(95％CI:1.354,7.007)]、NLR 升高[OR=4.175(95％CI:1.835,9.496)]、TG/HDL-C 升高[OR=2.735(95％CI:1.202,6.221)]、CRP/Alb 升高[OR=3.168(95％CI:1.393,7.206)]为腹膜透析患者死亡的危险因素(P＜0.05).ROC曲线分析结果显示,TG/HDL-C、CRP/Alb及两者联合预测腹膜透析患者死亡的敏感性分别为86.96％(95％CI:0.564,0.892)、84.78％(95％CI:0.541,0.873)、86.96％(95％CI:0.568,0.893),特异性分别为 87.42％(95％CI:0.572,0.898)、82.12％(95％CI:0.522,0.872)、96.03％(95％CI:0.679,0.982),曲线下面积分别为 0.863(95％CI:0.785,0.918)、0.796(95％CI:0.716,0.867)、0.930(95％CI:0.870,0.968)(P＜0.05).结论 腹膜透析患者死亡风险较高,多因心血管事件死亡,TG/HDL-C、CRP/Alb可用于预测腹膜透析患者死亡风险,且两者联合具有更高的预测价值.
Abstract
Objective To investigate the value of triglyceride(TG)/high-density lipoprotein cholesterol(HDL-C)combined with C-reactive protein(CRP)/albumin(Alb)in predicting the risk of death among patients on peritoneal dialysis.Methods The clinical data of 197 patients with chronic renal insufficiency undergoing peritoneal dialysis in the Second People's Hospital of Jingdezhen City and the Third People's Hospital of Jingdezhen City from January 2017 to December 2022 were retrospectively analyzed.According to the death of patients on peritoneal dialysis,they were divided into the death group and the survival group,and the clinical data of the two groups were compared.Multivariable stepwise Cox regression was used to analyze the risk factors for death among patients on peritoneal dialysis.The receiver operating characteristic(ROC)curve was plotted and the area under the curve(AUC)was applied to evaluate the predictive value of TG/HDL-C,CRP/Alb and their combination for death among patients on peritoneal dialysis.Results Forty-six of 197 patients on peritoneal dialysis died,with the mortality rate being 23.35％.The age,proportions of coronary heart disease,diabetes mellitus,hypertension,and statin use,platelet count,white blood cell count,neutrophil count,neutrophil to lymphocyte ratio(NLR),TG/HDL-C,and CRP/Alb in death group were higher than those in the survival group(P＜0.05).The lymphocyte count and the level of total bilirubin in the death group were lower than those in the survival group(P＜0.05).Multivariable stepwise Cox regression revealed that advanced age[(OR)=3.080(95％CI:1.354,7.007)],high NLR[(OR)=4.175(95％CI:1.835,9.496)],high TG/HDL-C[(OR)=2.735(95％CI:1.202,6.221)]and high CRP/Alb[(OR)=3.168(95％CI:1.393,7.206)]were risk factors for death in patients on peritoneal dialysis(P＜0.05).ROC curve analysis showed that the sensitivities of TG/HDL-C,CRP/Alb and their combination in predicting the death of patients on peritoneal dialysis were 86.96％(95％CI:0.564,0.892),84.78％(95％CI:0.541,0.873),and 86.96％(95％CI:0.568,0.893),with the specificities being 87.42％(95％CI:0.572,0.898),82.12％(95％CI:0.522,0.872),and 96.03％(95％CI:0.679,0.982),and the AUCs being 0.863(95％CI:0.785,0.918),0.796(95％CI:0.716,0.867)and 0.930(95％CI:0.870,0.968),respectively(P＜0.05).Conclusions Patients on peritoneal dialysis are at a high risk for death,and most of them die due to cardiovascular events.TG/HDL-C and CRP/Alb can be used to predict the risk for death in patients on peritoneal dialysis,and the combination of the two yields a higher predictive value.
基金项目
江西省自然科学基金(2020BABL206028)
国家科技期刊平台
NSTL
万方数据